Clinical Site Application Summary Contained in this submission is the CPCCRN Los Angeles Center's reapplication for continued membership in the Collaborative Pediatric Critical Care Research Network. The center is a partnership between the two major universities within the Los Angeles area, the Children's Hospital of Los Angeles (USC) and Mattel Children's Hospital UCLA (UCLA). Both sites have been members of the CPCCRN for the last five years and have been participating in conducting clinical studies under the CPCCRN. The partnership has continued to be strong between the two sites and it is the intention of both to participate in the network as a combined site. Concept Application Summary The purpose of this study is to compare two different early lung protective ventilation strategies (high frequency oscillatory ventilation versus pressure controlled conventional ventilation) for children with acute lung injury. In order to overcome limitations highlighted in previous trials on pediatric Acute Lung Injury, non-invasive markers of lung injury will be used to both improve patient enrollment and characterize risk. Application of already developed computer-based decision support tools will ensure replicable clinical decisions for equivalent patient states and improve protocol adherence. Neurodevelopmental and pulmonary outcome measures from Acute Lung Injury will be evaluated to examine morbidity and mortality beyond the PICU discharge. PUBLIC HEALTH RELEVANCE: Site Application Relevance: Continued membership of CHLA-UCLA in the network provides a broader range of expertise and larger multi-ethnic patient population by having two major universities contributing to its goals. Concept Relevance: The study seeks to evaluate the effects of early high frequency oscillatory ventilation compared to lung protective pressure control ventilation on short and long term morbidity and mortality.